Drugs for smoking cessationBMJ 2016; 352 doi: https://doi.org/10.1136/bmj.i571 (Published 23 February 2016) Cite this as: BMJ 2016;352:i571
- Jamie Hartmann-Boyce, research associate and DPhil student1,
- Paul Aveyard, professor of behavioural medicine1
- 1Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford OX2 6GG, UK
- Correspondence to: J Hartmann-Boyce
What you need to know
Consider prescribing nicotine replacement therapy, varenicline, or bupropion to most patients starting an attempt to quit smoking
When prescribing stop smoking drugs, stress the importance of commitment to total abstinence from the quit day onwards; adding behavioural support increases the chances of success
Nicotine replacement therapy is safe and is more effective if a patch is combined with a short acting form
Do not prescribe varenicline or bupropion in pregnancy, and avoid bupropion in patients at higher risk of seizures
Monitor people taking varenicline or bupropion for adverse psychological reactions
A 49 year old woman who smokes attends the general practitioner for help with troubling menopausal symptoms. During the course of the consultation, the doctor offers her help to stop smoking. She has tried stopping smoking previously without help and found it intolerable. She asks if she can use drug therapy this time.
What are drugs for smoking cessation?
Of the drugs available for smoking cessation, three are widely licensed and have proved efficacy:
Nicotine replacement therapy (NRT)—available as patches or as shorter acting oral forms (lozenges, chewing gum) or nasal sprays; reduces urges and withdrawal symptoms by substituting for nicotine inhaled via tobacco smoke1
Oral varenicline—a nicotinic receptor partial agonist that binds less effectively than nicotine2
Oral bupropion—seems to be a nicotinic receptor antagonist with dopaminergic and adrenergic actions; it may work by blocking effects of nicotine, relieving withdrawal, or reducing depressed mood.3
How well do they work?
Cochrane reviews give strong evidence that all three drugs are effective. Compared with placebo, the relative risks of abstinence are 1.60 (95% confidence interval 1.53 to 1.68) for NRT, 1.62 (1.49 to 1.76) for bupropion, and 2.27 (2.02 to 2.55) for varenicline.1 2 3 These relative risks seem to be constant over time from early in the quitting process to the long term and do not depend on …